1. 10/5/2015

11. Hypertension GuidelinesDate JNC JNC 72003 JNC 82013 NICE Guidelines 2011 ESC / ESH Hypertension Guidelines ESC Guideline2007 Reappraisal of 2007 Hypertension Guidelines September 2009

13. 10/5/2015  The JNC 8 guidelines released towards the end of 2013, had several new things to offer  One highly discussed recommendation was that for patients aged 60 or above who don’t have DM and CKD, the target BP of 150/90 (instead of 140/90)…  The American society of hypertension and the European society for hypertension have stuck to the previous guidelines of 140/90.While BP of 150/90 may be acceptable, there is a consensus on evidence that with a target of 140/90 we are more sure about the reduction in risk of CVD and  For patients between 18 to 59 years and those who not have DM and CKD,the target BP is 140/90.

14. 10/5/2015 1.Not evidence based recommendation 2. Recommendations by expert opinion only 3.Not unanimous, 5 members of the panel have disagreed 4.All societies have not accepted those recommendations 5.Some what controversial

15. 10/5/2015

43. SYMPLICITY HTN-3 SYMPLICITY HTN-4 RandomizedYes ControlledYes BlindedYes Number of subjectsMore than 500 Number of Centers Participating Up to 90 in the USUp to 100 in the US Blood Pressure Required for Inclusion > 160 mmHg Systolic 140-160 mmHg Systolic

44. 10/5/2015

45. 1. Hypertension is the commonest clinical disorder and is a major health problem worldwide. 2. Inadequately controlled or uncontrolled hypertension leads to subclinical organ damage which can be progressive, leading to serious cardiovascular events like angina, MI and CHF, TIA and stroke, chronic renal failure, peripheral vascular disease and retinopathy. 3. Optimization of drug therapy with 1, 2 or 3 anti hypertensive agents in combination and /or full doses may be necessary.

46. 4. Ambulatory and home B.P. monitoring should be encouraged 5. JNC 8 defined new target goals and has advised first line drugs and later line therapy. 6. Renal denervation therapy initially showed significant promise but in randomized blind trials with sham procedures, there was no significant difference in the B.P. levels upto 6 month in RDT vs control patients.

47. 7. Some reports suggest benefit in uncontrolled hypertension with chronic renal failure. 8. Life style modification, reduced salt intake prevention of diabetes and obesity, cessation of smoking and use of appropriately tailored drug therapy can prevent end organ catastrophies.